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Joint pain

Pain in the joint in a medical language is called arthralgia. This is a very significant symptom for the diagnosis of multiple diseases, is one of the first symptoms that reflects the damage of the joint at the organic level (more often irreversible biochemical and immunological disorders), followed by the development of arthritis (with the exception of drug and meteopathic arthralgia).

Possible causes of pain in the joints.

Arthralgia arises as a result of irritation of neuroreceptors, which are found in all joint structures, by various factors depending on the underlying disease. One of the causes of joint pain can be a joint injury and the formation of a hematoma that is not visible to the eye.

The main diseases in which there is pain in the joints.

Osteoarthritis is the most common chronic joint disease (often the hip, knee, interphalangeal joints of the hands), which is based on degenerative - dystrophic disorders (metabolic disorders) of articular cartilage, bone tissue, synovial membranes and ligamentous joint apparatus (elderly, overweight, impaired metabolism, trauma, lack of vitamins C and D, occupational hazards).

Symptoms - pain and stiffness in the joint that increase with physical activity and decrease at rest (with mechanical pain), constant dull night pains - disappear in the morning with active movements (with vascular pains), starting pains - quickly appear and disappear at the beginning of the load and return with intensive and prolonged exercise, blockade pains - wedging or infringement of the affected cartilage between the articular surfaces.

Soft tissue edema and local temperature increase in the joint area. Characteristics of the nodules of Geberden and Bushard (solid small formations) in the area of interphalangeal joints of the hands are characteristic.

Ankylosing spondylitis (Bechterew-Marie's disease) is a chronic inflammation of the joints of the axial skeleton (intervertebral, sacroiliac, rib-vertebral), which is based on the immune-inflammatory process in the body, followed by the formation in the joints of scar tissue with microelements and salts , which leads to a limitation of joint mobility. Symptoms - the first occur at a young age, aching constant pain in the buttocks, sacrum and waist, intensifying at night.

Reactive arthritis is an inflammatory acute disease of the joint (mainly the joints of the lower extremities). The reason - arises after the transferred acute infection (intestinal, acute respiratory viral infection, acute respiratory disease, urogenital). Symptoms. The constant acute pain in the joint is aggravated by movement, puffiness and hyperemia (redness) of the soft tissues over the joint, fever (38,6 - 40,0). Extra-articular manifestations - defeat of the eyes (conjunctivitis), heart damage (myocarditis, pericarditis, arrhythmias), CNS damage (neuritis, encephalopathy), kidney damage (pyelonephritis), trophism of nails, skin and mucous membranes (onychodystrophy, keratodermia, erosion).

Regarding infections, arthralgia may be a symptom of the Zick virus.

Disease Reiter (a separate type of reactive arthritis with a genetic predisposition) - manifested after a chlamydial or intestinal infection. It is manifested by reactive arthritis (mainly the joints of the lower extremities), joint pain, characteristic extraarticular manifestations (urethritis or prostatitis, conjunctivitis or uveitis, skin and mucous membrane damage - ulcerative stomatitis, erosive balanitis), cardiovascular damage (arrhythmia, blockade, aortitis), fever (38.6 - 40.0).

Rheumatoid arthritis is a chronic progressive systemic inflammation of connective tissue (autoimmune inflammation in the joint). Mostly small joints of hands and feet are affected, less often the knee and elbow joints. Symptoms - pain in joints is constant, joint deformity, joint swelling, joint stiffness in the morning, joint symmetry, weakness, fatigue, weight loss, increased body temperature and over the joint area, persistent joint deformity, rheumatoid nodules on the extensor surfaces, lesion bones (bone pains and fractures), skin lesions (dryness, pallor, subcutaneous hemorrhage, bright pink or bluish skin color, fine-focal necrosis of soft tissues under the nail plates), nail damage (friability, striation of the nail plates), lymphadenopathy (enlargement of the submaxibular, cervical, inguinal and ulnar lymph nodes), Felty syndrome (joint damage with a combination of splenomegaly - an increase in the spleen and leukopenia - a decrease in the number of leukocytes in the peripheral blood), lesion of the broncho-pulmonary system (interstitial fibrosis of the pulmonary tissue, unilateral pleurisy, rheumatoid nodules in the lungs), lesions of the gastrointestinal tract (associated with the intake of medications in the treatment of the underlying disease (myocarditis, endocarditis, pericarditis, coronary arteritis, aortitis, arrhythmias), renal damage (amyloidosis, glomerulonephritis, drug kidney), damage to the nervous system (neuropathy with sensory or motor impairment); defeat of the eyes (scleritis, keratoconjunctivitis).

Psoriatic arthritis - arthritis developing in genetically predisposed patients with psoriasis, exacerbation of arthritis coincides with exacerbation of psoriasis. Symptoms. Pain in the joint (mainly interphalangeal joints of the hands and feet), purplish-cyanotic skin with edema above the joint region, asymmetry of the joint, pain in the lumbosacral spine, pain in the heels (talalgia), skin psoriatic plaques, nail damage ( fragility, striation and turbidity of the nail plates).

Gout (gouty arthritis) is microcrystalline arthritis, a hereditary disease that is based on a metabolic disorder (in violation of diet), namely, purine metabolism, which results in the deposition of urate crystals (uric acid salts) in the near-articular and articular tissues. Symptoms. Pain in the joint (more often in the first metatarsophalangeal foot joint), bright hyperemia (redness), swelling and flaking of the skin above the joint, fever, increased local temperature of the affected joint area, skin manifestations in the area of ??the auricles, elbows, feet, brushes, in the form of (local accumulation of crystals of urate salts surrounded by granulomatous tissue), heart damage (myocarditis, endocarditis, pericarditis, coronary arteritis, aortitis, arrhythmias), renal damage (amyloidosis, glomerulonephritis).

Pseudogout - (pseudo-arthritis arthritis) microcrystalline arthritis, a disease in the basis of which there is a metabolic disorder (local disturbances in the metabolism of calcium pyrophosphate in the joint tissues), namely calcium metabolism, resulting in the deposition of calcium pyrophosphate crystals (calcium salts) in the articular and articular tissues . Symptoms. Pain in the joint (often affects the knee joints), bright hyperemia (redness), swelling of the skin above the joint, fever, increased local temperature of the affected joint, deformity of the joint. Internal organs and other systems are not affected at the same time.

Medicinal arthralgia is a temporary condition characterized by aching pains in the joints (mainly small joints) against the background of taking certain medications at high daily doses. It is not a disease, and is not classified in ICD-10 for WHO. Groups of drugs that can cause drug arthralgia - penicillin antibiotics, barbiturates and light hypnotic drugs and tranquilizers (on a chemical basis), antihypertensive drugs, contraceptives and antituberculosis drugs, proton pump inhibitors. Causes, pathogenesis, clinical manifestations and diagnosis of this condition are not studied, due to the active promotion of drugs on the pharmacological market and the lack of severity of the condition in relation to functional disorders of the joint and individual tolerance of medications.

The same can be said about meteopaticheskie arthralgia (pain in the joints of meteopathic people, sensitive to differences in atmospheric pressure).

Examination for pain in joints.

Clinical analysis of blood in most cases indicates various deviations depending on the nature of joint damage and the degree of its severity, an increase in ESR, reflecting the level of the inflammatory process, with a normal number of leukocytes is characteristic of rheumatic diseases. An increase in the number of leukocytes in inflammatory diseases of the spine, and joints may indicate the presence of a foci of infection in the body, etc. The biochemical analysis of blood for the diagnosis of certain inflammatory diseases of the joints and spine is very important in determining the content of C-reactive protein (CRP) in the blood serum, diphenylamine reaction (DFA), determination of the total protein and fibrinogen content, seromucoid, etc. Although all these tests Do not indicate the specificity of the pathological process, when compared with other clinical and radiological data, they assist in diagnosis in the early stages of diseases of the musculoskeletal system and allow to judge the level of activity of the process. Great importance is attached to the change in the content of lysosomal enzymes (acid phosphatase, acid proteinase, deoxyribonuclease, cathepsins) in serum and synovial fluid is often observed in rheumatism, Bechterew disease, psoriatic polyarthritis.

Immunological research. For early diagnosis of rheumatoid lesions, rheumatoid factor - antiglobulin antibody is of particular importance. It is formed in lymph nodes, spleen, synovial membrane with lymphoplasmocytic cells. To determine the rheumatoid factor in the serum and synovial fluid, the Vaaler-Rose reaction is considered positive when there is a concentration of 1:28 or more. Rheumatoid factor is detected in 75-85% of patients with rheumatoid arthritis. In the early stages and in the seronegative form of rheumatoid arthritis, the immunocytoaderence reaction is used to isolate the rheumatoid factor at the level of the lymphocyte.

A sample with antistreptolysin O (ASL-O) reflects immunological reactivity in relation to streptococcal infection. The increase in the titer of ACL-0 is observed in patients with rheumatism, infectious-allergic polyarthritis.

The reaction of inhibition of migration of leukocytes. Normally, leukocytes have the ability to migrate into the environment with the formation of conglomerates. If there is a sensitization of the organism to a certain antigen, then when the sensitized leukocytes meet this antigen, the lymphocytes release an inhibitory factor that inhibits the migration of leukocytes. This reaction is positive for rheumatism, rheumatoid arthritis and other rheumatic diseases.

Blood on the HLA system - the possibility of early diagnosis of Bechterew's disease, the definition of HLA B-27 is of great importance. The HLA complex is found in the cell membrane and is secreted by immunological methods.

Investigation of synovial fluid - on any pathological process that occurs in the joint, inflammatory, degenerative or traumatic, the synovial membrane reacts and can produce a large amount of exudate. It is mixed with the synovial fluid permanently contained in the joint cavity, in connection with which it acquires new immunobiochemical and histochemical properties. The change in the histological, physical and biochemical properties of the synovial fluid depends on the nature of the lesion, the stage and severity of the pathological process. Particularly important is the study of synovial fluid in the differential diagnosis of inflammatory and degenerative diseases of the joints. An acute inflammatory process is accompanied by an increase in the number of blood elements in the synovial fluid.

Immunoelectrophoresis - reveals immunoglobulins of classes A, G, M, which are of great importance for the development of the pathological process in rheumatoid arthritis.

Radiography is a reliable method of joint research. In fact, without her, the doctor can not establish a diagnosis and conduct differential diagnosis. X-ray examination allows you to determine the stage and prognosis of the disease, and in an objective way to evaluate the effectiveness of therapy. It is necessary to compare the radiographic data with the clinical picture, the duration of the disease and the age of the patient.

Tomography allows you to more accurately determine focal lesions or individual segments of the vertebrae.

Myelography is a contrast method of vertebral examination, with the help of this method it is possible to clarify the localization of the pathological process, especially in those cases when surgical intervention is necessary.

Intraosseous phlebography - to study the venous blood flow of the epidural space. This method allows you to judge the state of the circulatory system in the near-vertebral space and indirectly about a possible degenerative lesion.

Arthroscopy is a research method that allows you to visually view the structure of the knee joint and take a biopsy of the desired site, reveals contours, color and capillary network of the synovial membrane, cruciate ligaments, menisci and fat pad.

Discography - the introduction of a contrast medium into the intervertebral disc with subsequent radiography makes it possible to judge the state of the intervertebral discs, the localization and the extent of the lesion.

Radionuclide scanning is an important objective method of early diagnosis of joint damage.

Arthrography - with the help of intra-articular injection of various contrast agents, it allows to more accurately determine the pathology in deeply located articular parts.

Biopsy of the synovial membrane - a biopsy material for various joint diseases is crucial in the diagnosis of early forms of Bechterew's disease, Reiter's disease, gouty arthritis.

Symptomatic treatment: how to relieve pain in joints

We do not recommend self-treatment and treatment with folk remedies for any pain in the joints before a preliminary or definitive diagnosis is made by the attending physician due to an incorrect self-assessment of one's condition, which can lead to persistent irreversible functional disorders of the joint - ankylosis, stiffness, contractures (in this and is the danger of a symptom). Today, the most popular means for relieving joint pain are drugs from the NSAID group. They are really effective, but they have a number of contraindications and are not recommended for long-term use.

What kind of doctor should I consult for joint pain

Therapist, surgeon, orthopedist, traumatologist, arthrologist, rheumatologist. Consultation of a doctor is mandatory, with the first occurrence of pain in the joint and lasting more than 2 days.